Case Manager RNPrimary Location: Bethlehem, Pennsylvania
Additional Locations: PA-Bethlehem Apply
Office-based position in Bethlehem, PA.
We help our members live fuller and healthier lives while delivering positive financial results to our plan sponsors. Through integrity, compassion and commitment to best-in-class service, we educate members, facilitate treatment plans and partner with constituents to create innovative service models.
Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Utilizes case management processes in compliance with regulatory and company policies and procedures. This job requires excellent communication skills, Attention to detail, the ability to multitask and problem solve, and able to work in multiple web based applications simultaneously, Must be an independant thinker.Background Experience: RN licensure required
3+ years clinical experience required
Case management experience preferred
Managed care experience preferred Additional Job Information: Typical office working environment with productivity and quality expectations
Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor.
Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer.
Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
Effective communication skills, both verbal and written. Required Skills: General Business - Applying Reasoned Judgment, Leadership - Collaborating for Results, Leadership - Driving Change Desired Skills: General Business - Communicating for Impact, Leadership - Driving a Culture of Compliance, Technology - Leveraging Technology Functional Skills: Nursing - Case Management, Nursing - Concurrent Review/discharge planning, Nursing - Home Health Care Ambulatory Nursing, Nursing - Medical-Surgical Care Technology Experience: Aetna Application - Aetna Total clinical View, Desktop Tool - Microsoft Outlook, Desktop Tool - Microsoft Word, Desktop Tool - TE Microsoft Excel Education: Nursing - Registered Nurse Potential Telework Position: No Percent of Travel Required: 0 - 10% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
Jobs for you
Recently Viewed Jobs
You do not have any recently viewed jobs
Your Saved Jobs
You do not have any saved jobs
Sign up for Job Alerts
Join our Talent Community
At Aetna, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna.
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna.